Pediatric Associates of the NW Blogs

Tongue Tie in Context

Scott Spencer, MD, MPH
February 28, 2019 10:00AM

Knowledge about breastfeeding is as old as the dawn of time, but there is still plenty that is not known according to researchers. One area that needs more research is the area of impaired tongue function.  Impaired tongue function is the lack of coordinated tongue movement between the baby and the mother’s breast that causes an unsuccessful or painful latch. According to lactation researchers, there are many known and unknown causes of impaired tongue function. Fortunately, the known causes can be identified by a lactation consultant, such as those at Pediatric Associates of the Northwest. These causes include positioning and timing of breastfeeding, health of the mother and child, maternal breast variations and infant mouth or tongue variations. Many experts say however, that there is as much unknown about how more complex factors affect tongue function – such as baby/maternal stress in the brain or body.  How these issues affect impaired tongue function is an area of significant research.  

One cause of impaired tongue function is called tongue tie, which can be diagnosed as either anterior or posterior tongue tie. Anterior tongue tie is relatively simple to diagnose by the appearance of a “heart shaped tongue,” a tongue that doesn’t extend beyond the lips, and the presence of a prominent thin membrane under the tongue near the tip. This tethering of the tongue may cause impaired tongue function. If recommended, the treatment for anterior tongue tie is simple and the side effects are minimal.

The diagnosis of a posterior tongue tie is more complex. Certain otolaryngologists (Ear, Nose and Throat specialists) diagnose posterior tongue tie. The diagnosis is based on impaired tongue function. However, researchers are aware that the cause of impaired tongue function has many known and unknown causes. They believe that some of what is identified as posterior tongue tie may be from another cause of impaired tongue function.  These same researchers, as well as some pediatricians, lactation specialists, and pediatric specialists are concerned that posterior tongue tie is over diagnosed and over treated.  When a condition is being over treated, it runs the risk of causing harm.  Some pediatricians have reported that in certain children it can make breastfeeding worse and can even cause long term feeding difficulties.  There have been no high quality, long term studies on the outcome of posterior tongue tie treatment.  Until research advances, I think it is important to work closely with your pediatrician and lactation consultant to determine the best care for your baby. If you have questions or are concerned about tongue tie, please call our office for an assessment.